Forensic pharmacology

FORENSIC
PHARMACOLOGY
Dr. Harshad Malve
MBBS, MD (Pharmacology)

INTRODUCTION
Pharmacology
• Focuses on the knowledge of action and interaction of different chemicals in living
beings
Forensic
Pharmacology
• Application of Pharmacology knowledge to legal issues such as resolving litigations,
drug regulatory process, and the criminal justice system such as determining cause of
death in crime scenes
• Increasing forensic science courses in schools and colleges in countries like USA and
Australia
MALVE HO. FORENSIC PHARMACOLOGY: AN IMPORTANT AND EVOLVING SUBSPECIALTY NEEDS RECOGNITION IN INDIA. J PHARM BIOALLIED SCI. 2016 APR-JUN;8(2):92-7. DOI: 10.4103/0975-7406.171698. PMID: 27134459; PMCID:
PMC4832912.
2

FORENSIC PHARMACOLOGY: NEED OF THE HOUR
 Needs recognition among the Indian pharmacologists
 “Pharmaceutical Jurisprudence” is an extensively studied branch of pharmacy curriculum in India
 New drugs (few are Smart Drugs) leading to new ways of abuse
 Advances in analytical techniques and application of biotechnological advances to pharmacology and
toxicology has widely extended the understanding and overall scope of these subjects
 Pharmacology beyond therapeutics
 Scope for further research
MALVE HO. FORENSIC PHARMACOLOGY: AN IMPORTANT AND EVOLVING SUBSPECIALTY NEEDS RECOGNITION IN INDIA. J PHARM BIOALLIED SCI. 2016 APR-JUN;8(2):92-7. DOI:
10.4103/0975-7406.171698. PMID: 27134459; PMCID: PMC4832912.
3

SCOPE OF FORENSIC PHARMACOLOGY
Forensic
Pharmacology
Drug
abuse
Doping
Drug
overdose
Drug
Interactions
Adverse Drug
Reactions
Chemical
Hazards
Crimes under
influence of
Drugs
MALVE HO. FORENSIC PHARMACOLOGY: AN IMPORTANT AND EVOLVING SUBSPECIALTY NEEDS RECOGNITION IN INDIA. J
PHARM BIOALLIED SCI. 2016 APR-JUN;8(2):92-7. DOI: 10.4103/0975-7406.171698. PMID: 27134459; PMCID:
PMC4832912. 4

DRUG ABUSE
[CATEGORY
NAME],
[VALUE]
[CATEGORY
NAME],
[VALUE]
[CATEGORY
NAME],
[VALUE]
[CATEGORY
NAME] 3% ,
[CATEGORY
NAME],
[VALUE]
WAYS OF DRUG ABUSE AMONG INDIAN
MALES AGED 12–60 YEARS
Crimes under the
influence of a drug or
medication are the most
frequently reported ones
A national survey conducted by the Indian Ministry of Social Justice
and Empowerment in 2004
MALVE HO. FORENSIC PHARMACOLOGY: AN IMPORTANT AND EVOLVING SUBSPECIALTY NEEDS RECOGNITION IN INDIA. J PHARM BIOALLIED SCI. 2016 APR-JUN;8(2):92-7. DOI: 10.4103/0975-7406.171698. PMID: 27134459; PMCID:
PMC4832912.
5

• Drugs may get involved in
criminal & civil matters of
personal injury, motor vehicle
accidents, drug overdose and
murder
• Drug actions and their addiction
liability has profound medico-
legal implications
Category Examples
CNS stimulants Cocaine
Heroin
Marijuana
Tobacco
Amphetamine-related
drugs
CNS depressants Alcohol
Benzodiazepine
Opioids
Hallucinogens Lysergic acid
diethylamide
Mescaline
Phencyclidine
Dissociative anesthetics Ketamine
Inhalants Chloroform
Anabolic steroids
DRUG ABUSE
MALVE HO. FORENSIC PHARMACOLOGY: AN IMPORTANT AND EVOLVING SUBSPECIALTY NEEDS RECOGNITION IN INDIA. J PHARM BIOALLIED SCI. 2016 APR-JUN;8(2):92-7. DOI: 10.4103/0975-7406.171698. PMID: 27134459;
PMCID: PMC4832912.
6

 World Anti-Doping Agency guidelines
 National Anti-Doping Agency: National organization responsible
for promoting, coordinating, and monitoring the doping control
program in sports with a vision of “dope free” sport in India
 A forensic pharmacologist can help with:
 Use of analytical methods to detect the doping
 Help in avoiding accidental use of ergogenic drugs by athletes
 Advise on the drug interactions and use of drugs for therapeutic
purposes in athletes
 Commonly used ergogenic drugs
(performance enhancing agents)
 Anabolic steroids
 Narcotic analgesics
 Diuretics
 Beta blockers
 Growth hormone
 Oral peptide hormones
 Amphetamines
 Caffeine
 Cocaine
 Sympathomimetic agents
 Erythropoietin
SPORTS MEDICINE &
DOPING
MALVE HO. FORENSIC PHARMACOLOGY: AN IMPORTANT AND EVOLVING SUBSPECIALTY NEEDS RECOGNITION IN INDIA. J PHARM BIOALLIED SCI. 2016 APR-JUN;8(2):92-7. DOI: 10.4103/0975-7406.171698. PMID:
27134459; PMCID: PMC4832912.
7

DRUG LEVELS IN BLOOD
 Forensic pharmacologist can assess & analyze the blood samples to determine:
 High and borderline doses
 Signs of toxicity
 Lack of therapeutic effect, or a suspected case of poor adherence
 Alterations in postmortem and ante-mortem blood levels
 Monitor the narrow therapeutic range of different drugs such as:
 Digoxin
 Lithium
 Theophylline
27134459; PMCID: PMC4832912.
8

DRUGS, ALCOHOL,
AND DRIVING
 Making an informed decision in medico-legal cases
 Interpreting the serum concentration of alcohol and its
effects
 Impact of drug interactions on alcohol absorption or
metabolism, and the disease state
 Medico-legal implications of alcohol or drug abuse
 Forensic pharmacologist is
armed with the knowledge of
• Pharmacokinetics
 Pharmacodynamics
 Drug interactions
 Adverse reactions
27134459; PMCID: PMC4832912.
9

CRIMINAL CASES
 Important role in a wide range of criminal cases
 Provide a testimonial such as:
• Use of drug or poison as a weapon
• Mental impairment caused due to the effect of a medication
• Use of a specific drug as the reason for criminal aggression
• Drug use and their effect on the victim
• Drugs are frequently used in suicide attempts and as a tool of homicide or sexual assault
• The most commonly used date drugs are flunitrazepam, alcohol, gamma-hydroxybutyrate, and
ketamine
27134459; PMCID: PMC4832912.
10

FORENSIC
PHARMACOVIGILANCE
 Role of PV in forensic cases:
• Establishing the effects of the drugs leading to crime
• Use of counterfeit products , contamination, adulteration, or
other substandard medicinal products leading to adverse drug
reactions
 Role of PV in civil cases
• Previously unsuspected class effect emerges when the drug is
available in public domain after licensing e.g. Thalidomide
tragedy, Bladder cancer with use of Pioglitazone, and
subsequent temporary ban in India
 Differs from Pharmacovigilance as it considers the medico-legal
implications as well
Pharmacovigilance (PV) is science
related to the adverse effects or
any other drug-related problems
27134459; PMCID: PMC4832912.
11

OFF-LABEL DRUG USE
 Civil cases which involve review of insurance claims
 Review the use of “off-label” use of a drug and enable the initiation of a malpractice law suit
 Testify about the appropriateness and urgency of the unlabeled use of a drug
 Case for Medical Negligence
27134459; PMCID: PMC4832912.
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ENVIRONMENTAL TOXICOLOGY AND ECOTOXICOLOGY
 Urbanization and industrialization leading to environmental pollution and subsequent morbidities
or mortalities
 Importance of teaching regarding prevention, monitoring, evaluation, diagnosis, and treatment of
toxic exposures including intentional, unintentional, occupational, and environmental exposures
 A forensic pharmacologist can play an important role in spreading the awareness about
evaluation, diagnosis, treatment, and prevention of toxic exposures and also help in resolving the
medico-legal issues surrounding it
27134459; PMCID: PMC4832912.
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ROLE OF FORENSIC PHARMACOLOGIST
Conduct analysis of body fluids and tissues and interpret the data to help the attorneys in assessing the
role of a drugs or specific chemicals in the behavior, illness, injury, or death of an individual
Analyze, assess, review, and support the attorney’s position
Provide a written report if his review positively supports the attorney’s case
Testify in case of a trial to explain the findings in court
Help the attorney in preparation for cross-examination of expert on the opposite side
27134459; PMCID: PMC4832912.
14

CAREER PATH OF A FORENSIC PHARMACOLOGIST
 An expert to isolate, identify and quantify drugs, and chemicals in biological materials
 Expert in all drug-related topics which may include:
1. Prescription or dispensation of the wrong drug
2. Use of counterfeit drugs
3. Incorrect storage of drugs
4. Incorrect calculation of dosage
5. Administration of a wrong dose
6. Harmful drug interactions
7. Adverse events related to drug use
8. Adverse drug reactions
 A forensic scientist in the domain of forensic practices
15
MALVE H. UNDERSTANDING FORENSIC PHARMACOLOGY: WHAT INDIAN PHARMACOLOGISTS NEED TO KNOW? TOXICOL INT. 2016;23(2):205-6.

SERVICES PROVIDED BY FORENSIC PHARMACOLOGIST
Administrative
•Employment testing
•Patents
•Scientific fraud
Clinical
evaluation
•Inappropriate use of chemical agents
•ADR & drug interactions
•Date rape drugs
•Drugged and drunk driving
•Drug-induced violence
•Impaired capacity
•Medication errors
•Poisoning or substance abuse
Distributive •Adulteration or contamination of drugs
•Use of counterfeit drugs
MALVE HO. FORENSIC PHARMACOLOGY: AN IMPORTANT AND EVOLVING SUBSPECIALTY NEEDS RECOGNITION IN INDIA. J PHARM BIOALLIED SCI. 2016 APR-JUN;8(2):92-7. DOI: 10.4103/0975-7406.171698. PMID: 27134459; PMCID: PMC4832912.
16

STATUS OF FORENSIC PHARMACOLOGY IN INDIA
 Not well-developed nor implemented correctly
 No clear delineation of the knowledge, skill, and hence work of the specialty
or subspecialty
 Globally several teaching institutes and universities have dedicated centers “that teach Forensic
Pharmacology”
 Example: American Institute of Pharmaceutical Sciences has a dedicated “Center for Forensic Pharmacology.” South Dakota
State University and the City University of New York also offer courses of Forensic Pharmacology
 No integrated course that focuses on Forensic Pharmacology as a specialized subject even in MBBS
curriculum
 An evolved system of Forensic Pharmacology is needed
 Rise in the medico-legal cases related to the use of drugs is alarming the need of forensic pharmacologist
MALVE H. UNDERSTANDING FORENSIC PHARMACOLOGY: WHAT INDIAN PHYSICIANS NEED TO KNOW? J ASSOC PHYSICIANS INDIA. 2017 FEB;65(2):74-75. PMID: 28457036. 17

CONCLUSIONS
 In cases where validation cannot be made between the uses of a drug with a specific associated
outcome, it becomes difficult for a judiciary to offer radical explanation.
 In such cases, a forensic pharmacologist can make a useful contribution by utilizing his or her
knowledge of drug-related problems and pharmacology to provide relevant results and data which
is helpful in assisting the legal system to take the right decision.
 Medical education in India needs to focus on developing Forensic Pharmacology as a subspecialty
27134459; PMCID: PMC4832912.
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